On Wednesday, I wrote about Dr. Brad Bootstaylor and See Baby Midwifery. DeKalb Medical Center restricted Dr. Bootstaylor’s privileges allegedly in the wake of a profoundly injured baby resulting from an attempted homebirth after two previous C-sections.

What about the babies who have been harmed? Who gives a shit?

Apparently that was one injured baby too far, and DeKalb moved to protect mothers and infants (and itself) from a doctor who allegedly violated evidence based standards of care in obstetrics and demonstrated lack of clinical judgment and skill; even his supporters acknowledge that “forceps are not his strong suit.”

How dare the hospital try to protect babies and mothers from allegedly incompetent and dangerous providers? Who gives a shit about injured babies and heartbroken mothers? Certainly not the narcissists in the protest group organized to oppose the dastardly requirement for clinical competence.

They got a lawyer, the husband of one of See Baby’s pregnant clients, Zawn Villines, and began threatening the hospital.

She explains:

By Sunday, we were prepared to begin writing letters. Jeff [Filipovits] sent his first lawyerly letter to the hospital, and many group members began doing the same. This letter-writing campaign continued, and group members began sharing their letters. Jeff had numerous communications with the hospital, was threatening a lawsuit, and knew the specific causes of action under which he could file one.

Then, like a bad penny, Dawn Thompson from ImprovingBirth.org turns up counseling more intimidation:

Dawn Thompson of ImprovingBirth. org got in on things to offer us behind-the-scenes help. She suggested the second protest on Labor Day that we began using as a threat. Many other birth advocates and professionals also got involved early to lend resources. They include, but are not limited, to Brenda Sanders Parrish, Debbie Pulley, Kim Baxley Wilson, and so many more.

Then they met with the hospital to threaten them with a barrage of lawsuits:

Wednesday, we met with the hospital. Jeff made various legal threats. We all made threats. It was not at all a friendly meeting. In fact, I would say that members of our group were more hostile, more aggressive, and more demanding than I have ever seen anyone be in any other negotiation. They were also smart. We didn’t go in and yell. We went in prepared to ask legal questions, to accuse their lawyer of practicing medicine without a license, to threaten lawsuits over forced episiotomies, and so much more.

What about the profoundly injured HBA2C baby and other babies who have been harmed? Who gives a shit? Certainly not the “birth warriors” threatening the hospital.

They were planning their next protest when the hospital’s lawyer called, offering:

*Reinstatement of Dr. B’s VBAC and vaginal breech delivery privileges (except for VBAC3)
*Agreement to provide us with full details about the water birth vote on Monday, as well as agreement that we will get full details about future actions well before October 31.
*Reinstatement of vaginal breech delivery (Dr. B is still the only physician currently providing it)…
*Relaxation of IV and eating rules–please note they’re still saying it’s “hospital policy,” so you will need to be prepare to give a firm no.

What about the babies who have been harmed? Who gives a shit?

There was some sort of quid pro quo:

We canceled the protest for legal reasons we cannot disclose here. This is not an attempt at secrecy, but a recognition of the challenging realities of threatened litigation and hospital politics.

Please understand that if we still had the protest, it is very likely we would lose every single gain we made. That affects real laboring women right now. Their lives are different and better because of this movement. No one’s life has been made worse because of this movement.

What’s next for these intrepid birth warriors?

*Targeted protests against problematic birth policies; we could be like a birth strike force.

A new, moderated group that requires a signed commitment to confidentiality to avoid being infiltrated by the Skeptical OB and others (please note anything you say here is effectively public, since the media is here, as well as people who wish to make this group look foolish).

Hey, that’s not right! I’m not trying to make you look foolish. I’m trying to make you look like people who don’t give a shit about dead or injured babies, and you’re helping me do it.

No one has suggested that the hospital is acting for any reason other than to protect babies and mothers. Zawn Villines, Dawn Thompson et al. are threatening to sue the hospital to force them to STOP protecting babies and mothers.

It may be legal, but it is both ugly and unethical.

Update: See Baby Midwifery supporters are attempting to pitch NPR a story that DeKalb Medical Center is threatening women with with physical force.

Here’s how they intend to make the case:

***URGENT EMERGENCY POST PLEASE READ***

Some of you received emails for Joel Schuessler stating that women who refuse to exist the water birth tub would be “gently removed.” WE NEED THOSE RIGHT NOW.

L: … Here’s what mine said: “In the event that waterbirths are discontinued permanently, policies and procedures will be in place to safely removed mothers who wish to labor in water to another setting for delivery.”

Zawn: you may have just won this for us

But ACOG and the AAP have clinical guidelines that say waterbirth is dangerous for babies.

Can’t they just pull the plug on the waterbirth tub, making it drain? Or shut the valves off so that only cold water is available, so that no woman would want to be in the tub? That would certainly prevent any kind of physical persuasion.

SporkParade

I didn’t even understand the original statement as, “We will physically remove women from the pools.” It sounded more like, “Once delivery is imminent, we will help the women get out of the pools safely.”

Eater of Worlds

I’m assuming there will be clients so consumed with the woo they will stay in the tub with their joints locked, angrily kicking the water and splashing the water with their hands, like a toddler who doesn’t want to get out of the bath.

attitude devant

It has been a occasional practice for alternative types to ‘accidentally’ deliver in the water in hospitals where water labor was allowed but water birth wasn’t. Oops! (nudge, nudge, wink, wink) So you’re not too far off the mark.

Roadstergal

Seriously. If a woman wants to labor in a tub, and then follow ACOG guidelines and get out to deliver – or just doesn’t want to be in the tub any more for other reasons (comfort, pooping, already as pruned as she wants to get) – then you’re dealing, even if the patient is cooperative, with a pregnant-to-term woman, a high slip-and-fall risk, and potentially the woman in question screaming in agony and not very helpful for getting out of the tub. You want an SOP! For both safety and legal liability, I’d think…

The Bofa on the Sofa

OK, I just found a new comparison for safety of childbirth.

How about this one: The risk of being a policeman.

There is a lot of talk today about how the police are out there risking their lives, and putting their lives on the line every day, and how they have to treat every stop like a life-threatening situation.

I heard some stats about it this morning.

The risk of death for a policeman in the US _per year_ is 1/6600, or about .15/1000. Notice that that this is on the order of the risk of death for a “low-risk” childbirth.

And remember, that is the risk accumulated over the course of a year.

If you look at it per encounter (per arrest, let’s say) the risk is actually 1 in 100 000. (It is worth noting that the majority of police officer deaths result from 1) single car accidents and 2) heart attacks while on duty; only about 1/3 of all police deaths are caused by other people; the analysis above includes all deaths, though)

Even if you consider the risk of just assault, the risk per arrest is 1/1000. Compare that to the risk of an any adverse outcome in childbirth. Not even close.

So here’s the question: Is being a policeman risky? What would you think about something that increased the risk of being a policeman by a factor of 3? Would you find it horrific? Or would you pass it off as “the absolute risk is low “?

Because being a policeman is, in fact, less risky on the whole than being born.

guest

Puts all the whining about Blue Lives Matter into a different perspective, too.

The Bofa on the Sofa

You can interpret it that way, as well.

Eater of Worlds

Wait, I thought that was about the Smurfs and Gilgamesh.

guest

Not Gilgamesh, Galifianakis.

CSN0116

Take the comparison farther. If those are stats for all police — rural East bum fuck to inner city Chicago — then rest assured that the odds vary considerably per population… much like pregnancies vary considerably and some are high risk (i.e. being a beat cop in embattled Crips vs Bloods territory). So, per NCB, where people ironically don’t even participate in tests to inform them of risk (neither here nor there, really), a 43-week VBA3C free birth is as safe as a 40-week hospital birth just like skipping the bullet proof vest in Compton is as safe as skipping it in No-Man’s-Land, population 120.

prudentplanner

No-Man’s-Land is where they make the meth, have boobie-trapped marijuana fields, & everyone has guns.

A small suburban community with overlapping protection from the sheriff and State would be the safest place to be a police officer.

demodocus

OT: References to Greek mythology, LOTR, Star Trek, and writing the word kale in heiroglyphics in the space of 2 days. I love you all

Geek alert: I’m currently on the Island that the Irish Jokers are sent to in the Wildcard series.

There is a pub, a shop and wifi.
Other than that, pretty much Craggy Island from Father Ted.
We just walked past a priest in a soutane accompanied by several earnest young people in Tevas and knee length skirts and shorts.

“This cow is small, that cow is far away”.
“That would be an ecumenical matter”.
“Down with this sort of thing! Careful now”.

Any time I take my husband to within 50m of a lingerie department he asks me if it might be “the biggest ladies’ lingerie department in Ireland” before collapsing into giggles.

I’ve probably lost most of you…
If you ever get the chance, see it.
Father Ted is a wonderful TV show.

Bombshellrisa

“You’re running out of sandwiches, I’ll get you some more”
“Nuns! Nuns! Reverse! Reverse!”
I second Dr Kitty’s suggestion, Father Ted always makes me howl with laughter. (I wish I could somehow replicate Father Jack’s voice and stream the caravan episode here).

Monkey Professor for a Head

They put Father Ted on the Australian Netflix a few months back. I was sooo happy!

Nick Sanders

OT: A federal judge has refused to issue an injunction against SB 277. The law remains in effect as the lawsuit moves forward.

Of course they don’t give a shit about the babies, its all about the process of giving birth and the bragging rights they acquire through that process. The baby is just a waste product to them.

Melaniexxxx

yeah, chuck the baby out, but don’t forget to encapsulate the placenta!!

Marie Gregg

i always end up asking the same question after reading these things:

Why would any woman not want the highest standard of care during labor and delivery?

All I can conclude is that the “birth story” is more important than the health and safety of the baby, and that’s really sad. Narcissism at its worst.

nomofear

NCB literature and practitioners tell you that theirs IS the highest standard of care, that the medical industry leads with profit-based care over “evidence-based medicine,” that only they know about “physiological birth” – yes, once I’m out of it, it fairly drips with bullshit, but while in the thick of it, I bought it hook, line, and sinker. I also used the Internet a lot less seven years ago with my first child, while this site came up high on the Google return nearly two years ago when I put in “Ina Mae Gaskin,” and I was hooked. By actual reason and science this time, thank the gods. For instance, my mind was blown that epidurals don’t hurt babies, in fact they may even help them, since pushing often goes faster without pain. So, some of them, me included, have just been sold on lies out of a fear of hurting their babies. Others, yes, are narcissistic to the core, and no amount of actual fact will help them. But it’s always worth trying, in case they’re from the first set, like me.

Marie Gregg

Thanks for pointing that out. You’re right – not everyone is a narcissist. I need to strive to avoid painting with such a large brushstroke.

nomofear

But it is totally understandable that you’d react to it that way. And, it’s harder to excuse it now, when sites like this are relatively easy to find – of course, in NCB world, they proclaim often and loudly how evil Dr T is, so that may work on some folks, too. It’s not an easy line to walk, the one between patience and just wanting to throttle them

corblimeybot

Me too. I have friends who are great, intelligent, kind people who fell for NCB bigtime. Definitely not narcissists. I have to remind myself of that sometimes, because my experience with NCB people has been so cruel and bullying otherwise.

Azuran

I think part of the reason the NCB is getting so much traction is the fact that there is no actual ‘clear cut’ best standard of care when it comes to childbirth. It’s a VERY large grey zone with a lot of interpretation and a lot of room for various physician opinion.
And then long term outcomes are extremely hard to track down. Of all the things that end up affecting the development of a child, it’s near impossible to figure out what is or isn’t a birth related injury unless there was extensive documented brain damage at birth.

Right now, we have trouble even coming up with a proper comparison or the short/medium/long term complications of both VB or ECS. When we do have rates of some complications, we often don’t have accurate older rates to compare them to, so we can’t always be entirely sure if outcomes are necessarily better when the standards of care changes.

This amount of uncertainty is a huge help in boosting NCB’s credibility. They can fill in the gaps with pretty much anything. And call doctors evil for doing certain stuff without having a huge, clear cut, body of evidence to support it.

The Bofa on the Sofa

I think the reason the NCB is getting traction is for the same reason that drunk driving is so prevalent: because people can get away with it!

People drive drunk because they do it without incident. The absolute risk for drunk driving actually isn’t that high (lot less than childbirth) and so people can drive drunk for years without either a ticket or an accident. They think it won’t happen to them.

And they are usually right.

However, none of that changes the absolute fact that drunk driving is far more dangerous than sober driving, and, just being “usually right” that nothing will happen to them doesn’t make drunk driving acceptable.

Azuran

Yea, But you won’t convince any not drunk driving human with half a brain to start driving drunk by telling them the risk is actually minimal.

Roadstergal

Well, every drunk driving human starts off not drunk driving at some point. Something has to happen to convince them that it’s safe. Much like with homebirth.

Frex, Mr R comes from New Orleans, and he tells a story of going back to visit with a friend and seeing a sheriff driving around with an open beer in his cupholder. If the local fuzz are acting like it’s NBD, why should Joe Citizen think any differently?

I see that as being like the UK midwives. Home is perfectly safe, of course it is! And why should women think differently if that’s what the medical providers are telling them?

The Bofa on the Sofa

I disagree, actually. They will say, “You aren’t that bad, go ahead and drive” and that will convince them to do it.

And the fact that most drivers who get into fatal accidents are sober doesn’t change the fact that drunk driving is dangerous.

Marie Gregg

“Can fill in the gaps with pretty much anything.”

Nailed it.

CanDoc

I’m not entirely convinced that this is the case. There is extensive evidence and I can counsel women with both precise and accurate numbers about their risk of uterine rupture, fetal injury and death, maternal morbidity and death, in the even of VBAC based on maternal and labour characteristics. And then I use those numbers to help a woman make an “informed decision” about what kind of care and delivery she wants. Same thing for intrapartum care (monitoring, etc). Same thing for management of the post-term pregnancy. I’m not convinced that uncertainty is the problem. I think that the NCB community has promoted the idea that there’s a lot more uncertainty than there really is. And that because the absolute risks to the individual patient are low in most situations, and because the human brain understands risk poorly, that NCB is able to further seize the “tiny” risks and round them down basically to “zero” for women.

CanDoc

(in the “event” of VBAC not the “even” of VBAC)

AA

Commenter Antigonos said that during her midwife training in the 70s in Israel, staff had procedures to identify women who would be a reasonably safe candidate for planned homebirth. NCB is now saying that going the NCB route isn’t just reasonably safe, it’s safer. You will find CPM websites that say that planned homebirth is MORE safe for mother and baby than planned hospital birth, not just as safe.

My homebirth experience was entirely in the UK, where I studied midwifery, not in Israel. While not illegal, homebirth is definitely not approved by the Israeli Ministry of Health. And it needs to be noted that here, ALL midwives are also RNs (which nowadays means they have an academic degree), have done midwifery as a post-grad course, and must be licensed by the Ministry of Health. Recently, although the newspaper accounts have been exceptionally brief, there has been an infant death following a planned homebirth. Given the very small number of homebirths (maybe a couple hundred a year, max), and that it happened in Jerusalem, where I live, I bet I know the midwife, but I can’t get details.

Standards in the UK have sadly declined since my time there. Vetting of the pregnant woman as well as her home was extremely strict, so strict, in fact, that in the Cambridge area we had difficulty getting our required quota of homebirths that licensure demanded. The woman had to be a gravida 2, 3, or 4, without the slightest medical or obstetric problem in the current pregnancy or in previous pregnancies and births. A single blood count with a hemoglobin of less than 10 was enough to risk her out of a homebirth. The home had to meet certain criteria, and there was a dedicated ambulance service (Flying Squad) which carried enough staff and equipment to do a C/S in the home if transfer was thought too dangerous (never occurred during my time there), and there clearly delineated standards that required immediately summoning it during labor, for example, ANY bleeding more than bloody show, whether the mother agreed or not. We carried oxygen, the equipment for IV’s, and were licensed to give certain medications in certain doses and according to a certain schedule. It was very different from the American “anything goes” approach.

SporkParade

Do we know that it was a legal homebirth where the baby died? There are a few American CPMs here who get their birth jollies by attending the homebirths that Israeli CNMs won’t touch. I remember there was a case around the time my kiddo was born where a baby was seriously unwell after a birth that was only assisted by a doula, and there was some debate as to whether or not there had been plans to have a real midwife there, with the OBs generally saying, “And this is why we hate doulas so much.”

There is an unlicensed midwife practicing in the north, but AFAIK all the midwives who will attend homebirths in the Jerusalem region are licensed — some of them worked with me at the late, lamented Misgav Ladach hospital, and they are competent. The baby was transferred to Hadassah Ein Karem and died there. That’s all I know, and the media has been very reticent about what happened.

An unlicensed midwife is committing a felony if she attends a birth in the capacity of a midwife. Undoubtedly she would claim to be “only” a doula, but I doubt any court would believe her is she was actually caught red-handed, so to speak.

She does and she isn’t licensed. But there must be more than one because the last time I got fed up with an English-speaking Israeli parenting Facebook group and left, there was a woman who was fretting that her midwife wouldn’t arrive in time for her illegal home birth given that her first labor was quick and she has a family history of precipitous labor.

“This means that yet another bearer of the treasury of birth skills has been denied his God-given and self-determined path to the skills necessary for the preservation of the Human Right of birth for those coming bottom first.”

The doctor’s “God given rights” were violated. The babies’, notsomuch. WTH.

momofone

Well, sure–you can always make another baby, but there’s only one Dr. B!

Glia

Sniffle. My poor bottom-first baby. Someday I will have to explain to him about how he was not born. He will have so much trouble understanding.*

*Because it makes no sense. Luckily, I had access to a lovely c-section, so he will NOT have difficulty understanding due to hypoxic brain injury during breech birth.

Madtowngirl

My sister and I were “not born.” I’m pretty happy about that, since I am alive, grew up with my mother healthy and alive, and oh yea, I don’t have to visit the grave of my baby sister.

Fleur

Yeah, I used to go with my family as a child to visit the grave of my elder brother *. It really put the whole birth experience thing in perspective when the time came to have kids myself.

* an unmarked mass grave at the back of the churchyard – they weren’t very kind to babies who died before they could be baptised back in the 70s/80s and I was at university before my mother was given permission to put any kind of marker on the grave.

I had a CS because my son wouldn’t descend. Just like my mom had a CS because I wouldn’t descend. My son will quite happily relate that we waited all day for him to come out and then the doctor went in and got him, and that I wouldn’t come out either so the doctor went in and got me too.

Poor deluded kid. Never born and doesn’t even know it.

SporkParade

Well, I guess we all have a “God given right” to die. It’s just that most of us would rather not have that happen before our time due to forseeable, preventable causes. Seriously, I know people who were vaginally delivered despite being breech or twins because C-section was not an option where they were born. Anyone who thinks that’s the best choice for their baby is out of their mind.

Trixie

But…Gail’s whole marketing premise is that you can do her weird exercises and make your baby stop being breech. If breech birth is no big deal, according to Gail, why do we need Gail Tully at all?

Who?

It’s wootastic. If it ‘doesn’t work’, then that’s ok, she’ll fix it at the delivery anyhow, and you’ve lined her pocket. If it ‘does work’, she’s awesome, and you pay her anyway!

If only I had no morals, I’d be a rich woman today.

attitude devant

Is there something I don’t know about tort law in Georgia? Because I find myself wondering how this guy can get malpractice insurance. I don’t care how kind and well-meaning you are; if you deliver a baby with disability traceable to birth trauma while practicing OUTSIDE the standard of care, you WILL be sued. Parents need money to raise a disabled child, and you WILL be the deep pocket, no matter how much they praised you on Facebook. Maybe he just hasn’t been doing this long enough for the inevitable disaster to occur. Or, if it’s occurred, the court case is still in progress. But at some point the insurers are NOT going to want you on their books. We had a guy like this in our community. Everybody adored him (except for us obstetricians who thought he was a panderer and a fraud). After the THIRD baby with HIE, his insurer dropped him, and (since you have to have insurance to keep your hospital privileges), he went to Gyn only. And he wasn’t so hot at that either.

When people who know you describe your skills with forceps to be “not the best”, I suspect there have been more injuries than are widely known.

With my dark sense of humor, when I read his current care choices, I hear a defense lawyer saying “No, we should allow patients the right to choose the medical treatment of their choice which is why my client was performing lobotomies. None of his patients have complained about the outcome.”

Guest

There are multiple women who have been seriously injured but for some reason, women aren’t speaking out. The situation is disgusting.

I believe you. Based on what I remember and what my parents have said about the two medical malpractice moments involving us kids, having a dead or disabled child takes so much time and energy to simply survive that the parents don’t have anything left to work at changing the outcome during the first year or years after the incident.

Add in working through the parents’ feelings of guilt…..

I admire all the women and men who have fought the good fight to protect other families from the hell they experienced when their children were hurt or killed by NCB practices. That’s a group of heroes.

OkayFine

I am Guest from above and just signed up for a Disqus account to be able to comment easier. The crazy thing is that there have been issues and near misses going on for several years and people STILL aren’t speaking out publicly. There is an ardent group of supporters who don’t care about the stories coming out. It’s horrifying.

attitude devant

So glad you’re hanging around. Well, that answers my question. I wondered what was different about Georgia, and the answer is: not much. It just hasn’t had time to play out yet.

attitude devant

Can you share deets? We already know forceps are not his strong suit…..

OkayFine

I can share some details but not everything unfortunately and I have to be pretty vague. I know some people personally and feel wrong sharing their stories without express permission. But he supports almost all the local home birth midwives, CPMs, direct entry, etc. There was a stillbirth that happened under very questionable circumstances a few years back. Some patients are allowed to go very post dates, think 43-44 weeks. There were a few situations where cesareans or inductions were definitely indicated and were refused. There have been rumors floating around about HIE babies. It’s not good.

OkayFine

I’ve written and deleted several posts responding to you. Many of these situations happened to friends and I feel strange sharing them without express permission. The short version is women are allowed to go very post dates, like 43-44 weeks, are denied interventions even when they are very much needed, there have been injuries to moms and babies from forceps use, and a few years back there was a *very* preventable still birth that happened under questionable circumstances. People don’t speak out because they are so thankful for “birth options” and don’t want to ruin that for other women.

I’m guessing that he sincerely believes he is doing a good service for women. I’m guessing that those who support him think they are doing so under the banner of women’s autonomy in birth. That they are supporting a feminist cause. All of the bad stuff is easy to dismiss when it is under the banner of the greater good.

OkayFine

I’m trying to find balance in how much to share and have written and deleted several posts already. I personally know many people affected by his care and am not sure how much detail they would be comfortable with me sharing.

attitude devant

I’m sorry to put you on the spot. Please don’t do or say anything that makes you feel you are betraying a friend.

OkayFine

No worries, it’s just a fine line to walk. The questionable stories have been floating around for years but the number of issues seems to have escalated since he opened his own midwifery practice two years ago and switched over to Dekalb Medical. I’m assuming that they really didn’t know what they were signing up for when they allowed him to set up shop in their hospital. Prior to that he practiced out of Emory and Atlanta Medical Center (now renamed because it was bought out, I think?).

Amy Tuteur, MD

You can share your information with me privately (my email is in the sidebar) and confidentiality is assured.

attitude devant

Thanks for responding. Hmmm.

mabelcruet

Back to my dead baby stories-in 20 years I’ve dealt with 5 baby deaths caused by misapplied forceps or by complications of forceps. One baby’s head was turned the wrong way (he had a caput due to arrested labour and his orientation was difficult to assess, and ended up have traumatic injury to his cervical spinal cord), one had a massive comminuted and depressed skull fracture with intracerebral haemorrhage and massive necrosis, and 3 had subgaleal haemorrhage. I accept that subgaleal haemorrhage is a recognised complication, but 2 of the 3 had had multiple attempts at ventouse extraction and repeated attempts at getting the forceps placed. How many of them would have survived had they gone straight for section? I’ve also been involved in another case (as an expert witness) where the baby had occipital osteodiastasis with laceration of the cerebral sinus and ended up having brain tissue embolising to their lungs. OK, rare complications, but why run the risk?

I’m not an obstetrician, but my impression was that in at least some of my cases, the guidelines weren’t followed properly. I think you’re only supposed to try a certain number of times with a ventouse before you go to section, and in a couple of these there were multiple attempts. And the poor baby with the transected cord-that was hopelessly mismanaged. The mom was stuck at 9 cm for 5 hours but midwife didn’t see this as a problem. By the time a doctor was called the baby’s scalp was so swollen they couldn’t work out which way they were facing. I obviously only get to see the worst (fatal) cases but I think that as spinals and sections get safer, forceps deliveries are getting far less common.

An example: 45 years ago, a Scanzoni maneuver with forceps was routine for a persistent OP that was not going through the pelvis well. It turned the head, but if you didn’t know what you were doing, you could break the baby’s neck. Now, “failure to progress” due to persistent occipito-posterior position is a valid reason for C/S. But I’m sure you know this.

CanDoc

Wow. Those are some serious lapses in forcep use requiring more oversight, and terrifying to me to read. Your use of the term “ventouse” makes me wonder if you aren’t in North America. Were these deliveries performed by senior learners without supervision?
I’m partly curious as a labourist in a tertiary centre, performing several hundred deliveries a year (as do my practice partners – with about a 6-10% forcep rate and a 22% CS rate for the group), and I haven’t seen a single infant with a traumatic forcep injury like you describe in the 16 years I’ve been practicing. But every delivery is attended by a consultant, whether there are senior house staff involved or not. Stories like these of course lead me to wonder if we’ve just been lucky and if there’s anything else we could/should be doing to maximize safety in the operative vaginal delivery. (I don’t think the answer is more CS – the CS with the deeply engaged head is fraught with difficulty and complications, and our policy to is usually remove forceps at crowning to protect the pelvic floor at forceps delivery anyway).

mabelcruet

I’m not in North America. I’m a specialist pathologist and work in a regional centre, as opposed to an individual hospital, so these are cases from various different units, not all the same unit. One case was in a midwife led unit, the rest in district general hospitals (not academic/professorial/specialist units but staffed by consultant obstetricians) and all of them were considered to be low risk pregnancies. But even in a consultant led unit, most deliveries are carried out by a midwife if there were no known issues.

I think a common thread in most of them was failure to recognise that there was a problem and senior staff were’t called quickly. I know that in at least 2 of the cases, the hospitals concerned changed their policies (in one, one case, the hospital didn’t have ‘live-in’ medical staff, they were on call from home, and that was changed to live-in staff whilst on call, and in another the way the midwife led unit and the medical led unit interacted was changed to allow more medical supervision of women in the midwife led unit).

I’ve been “in the business” since 1967, and have seen certain kinds of forceps deliveries that simply are no longer performed because there’s no point to taking considerable risks and almost certainly causing trauma to the mother, if not to the baby, when a C/S is easier and safer to do. The attitude at the beginning of my career was that, with few exceptions, C/S was a “failure” to be avoided when possible. Some years later, I watched doctors who had emigrated from Romania who performed many of these outdated forceps techniques with great artistry. It turned out that under Caucescu, C/S was almost impossible, so doctors were forced to become extremely expert with forceps or they lost babies, and sometimes the mother as well.

mabelcruet

I think the skill is dying out though, the younger doctors simply don’t get the exposure to sufficient number of cases to develop the necessary expertise because section is seen as a preferred intervention. But I only see the fatal outcomes, maybe there are lots of forceps babies skipping around merrily, no harm done.

Guest

I live locally and have been following the Dr B situation for a good long while. There have been other babies/ mother who have been affected by his crappy care and I have no clue why someone hasn’t sued the pants off of him.

Thankfulmom

Why aren’t any of the parents of injured babies speaking up?

T.

My guess is that they either:

1. Are so deep in the woo that they don’t realize it was 100% preventable.

2. The children are small, so the disabilities are not as yet apparent to somebody who looks at the baby with rose coloured glasses.

See, the idiot some post back with the 24week ”Freebirthed” Baby.

OkayFine

All of that, plus women don’t want to be the ones who “take away other women’s birth choices.” There is a LOT of pressure to suck up the injuries and bad outcomes because he is the only dr who will back up homebirth midwives and will let women “make choices” about their care. People either don’t know or don’t care about the women and babies who have been injured. They say that women “informed decisions” so it’s okay because the women knew their options.

Elizabeth A

Thereally is a lot of anti-lawsuit pressure in the NCB community, but parents who do talk to malpractice lawyers are often advised not to speak publicly or socially about their cases.

The Bofa on the Sofa

Remember, the reason people go to doctors like this is because he is willing to do those things that other doctors won’t do. What he does is clearly outside the mainstream standard of care.

So what can they complain about? That he does things that are outside the normal standard-of-care? They can’t complain about that, because that’s why they went there in the first place, and if they were to complain about it, it would be an admission that THEY made a mistake in using him.

And that is why the won’t speak up – because it would call into question their judgement.

“My VBA2CS did not go well!”
“Yeah? That’s why most doctors DON’T DO VBA2CS! They are too risky.”
“Well this guy does them.”
“Yeah, and that’s why you went to him, because nobody else would do it. Don’t you think there is a reason for that?”

OkayFine

That’s a big part of it, I’m sure.

Mrs.Katt the Cat

Don’t forget their community of support- is likely full of people who would turn away or even against them if they went after the Dr. Look at how vehement the supporters are against the hospital.
They’re already dealing with a lot of stress, and probably know they could lose their social support system if they went for legal action.
The sad thing is they are not protecting the options of others, they are putting others in danger of having the same bad outcome by not speaking out. Going against a crowd if extremely difficult, it takes a special set of strength to ven start.

Maud Pie

Also, one of the underlying premises of NCB is that regulated professions and hospitals are too cold and impersonal and distant. They prefer to think of their practitioner as an intimate friend. That sort of connection discourages legal recourse. Emotionally and sentimentally oriented persons often don’t recognize how arm’s length professionalism protects their rights.

Azuran

Those who speak up against their NCB experience due to a damaged baby are usually hushed and pushed out by the community, so they are unlikely to still be part of the group.
Usually, those who are complaining publicly on social media tends to be the bullshit claims like ‘the doctor was a meany’ ‘I had an unnecessarian’ They don’t have an actual case and therefore only facebook will listen to them.
Those with actual real claims are going to take the proper legal route to get acknowledged and compensated. Also, anyone who is seriously considering or being part of a lawsuits
would be advised to avoid getting into public social media wars, as this could play against them in the ruling.

mabelcruet

There was a discussion a few years ago about independent midwives in the Uk who provided homebirth support-they were finding it very difficult to get insurance but laws were being brought in to make insurance mandatory. There was a suggestion that this was intended to ‘criminalise’ homebirth midwives as they would be forced to work without insurance because of the exorbitant costs and so be acting illegally. I can’t remember how it all panned out.

Maybe if they practiced to the standards AntigonosCNM mentioned upthread, they’d find it easier to get insurance… :p

The Bofa on the Sofa

Random OT comment: I was watching the National Geographic Channel last night about King Tut. They noted that his mother died when he was very young, and it is suspected that she died in childbirth.

I guess she didn’t trust her body enough, right?

Erin

Obviously she didn’t eat and drink enough during labour or maybe some servant hadn’t painted the birth affirmations clearly enough on the wall of wherever she was giving birth.

Roadstergal

What’s the Egyptian hieroglyphic for “kale”?

Erin

Apparently this:
Already to print out and stick on your wall for hieroglyphic affirmations!

AlexisRT

For what it’s worth, Dr. Tate does VBAMC and breech at Emory and is supposedly very experienced (and strict).

Trixie

I believe he only does VBA2C these days after the hospital limited him to that.

Guest

He is a *very* different provider than Dr Bootstaylor. He provides support for women seeking VBAC but is much more conservative with safety. He doesn’t touch homebirth midwives with a 10 foot pole.

CSN0116

Haha found one of those crazy-ass stories that Dr. T always seems to stumble upon. Behold:

1. No U/S until 20 weeks, because, meh – who needs one?
2. Finds twins by accident and thank God they were di/di
3. CNM drops her and her homebirth – good move, CNM
What does she do?
4. Let’s fucking free birth!
5. A bunch of “trust” and “my body can do this” rhetoric shit
6. Over 39 weeks with twins with no U/S surveillance or NSTs
7. Waters rupture but no labor for over three days – but she drinks water, so cool
8. But it all ends with the family in bed together, so yay!
9. She’s a lactation counselor and doula so it’s aight, y’all.

“Xavier and Alana’s Birth Story

Let me start from the beginning.
Right before thanksgiving 2015 we found out we were pregnant for the 2nd time and we were so thrilled! We had been planning a homebirth for the past two years and we had already found our midwife and everything before we found out we were pregnant! We started having prenatal appointments with her and I was measuring right on track for a singleton. I didn’t get an early ultrasound as I had been tracking my cycle and knew my dates, my midwife also didn’t require a 20 weeks anatomy scan but my husband and I were nosey and wanted to “know what we were having” we found out we were having TWO!! We were thrilled but in an instant our CNM was no longer able to attend our homebirth due to liability insurance reasonings. So we switched our care to the local military hospital. The whole time in their care I still felt as if the safest place for my babies and I during labor and delivery was at home, so I began researching all about unassisted childbirth/ freebirth. Chris and I were very comfortable with our plan, we trusted our instincts, trusted my body, trusted our babies, trusted God. So we made the decision to have our babies at home.

On July 19th(38+5weeks) I was feeling antsy in the house after a long weekend of preparing the house and finishing touches for babies that Chris and I decided to go for a walk down town and then to the mall. In the mall we got some ice cream with William, he was so excited to get such a treat and we walked the mall. Just as we were leaving the mall I felt a small “gush” and with each step I felt small amounts of fluid trickle into my pants. So I had to walk across the city with wet pants as my water continuing to trickle. Lol. it looked like I wet my pants. We headed home, took a shower and tried to get the house ready for labor. I wasn’t having contractions yet. Over the next 48hours I would have contractions on and off at different intensities. I drank 5liters a day to keep my fluids up and my waters continued to trickle. We went for multiple walks a day, I took baths, I bounced on my exercise ball, ate pineapple(no joke, like 5 pineapples), we watched movies with William, played games with him and tried to enjoy our last moments as a family of three. My water had started leaking on Tuesday afternoon by Thursday I was discouraged due to not having consistent contractions and labor yet but I trusted my body. Thursday night we went to dinner at our favorite pizzeria then we went for a car ride on the bumpiest road we could find! I had intense contractions the whole time so we headed home put William to bed then my husband and I watch 21 Jump street and 22 jump street as I bounced on the ball, contracting, laughing, enjoying each other. The whole night I had been having consistent contraction but I was so scared to go to bed that night because the last few nights I had the same thing and I would wake up the next day to no contractions and no babies. I convinced myself to go to bed around 1am. I woke up Friday morning, July 22nd, 2016, at 5:55am to an intense contraction and knew it was real. FINALLY!

I woke my husband and told him, “Today is the day!” I then prepared the bathroom for laboring. We have a nice cushiony camping/sleep map, I brought a chair in and stool turned the lights off and went to get dressed aka I put a bikini top on. All the while having strong contractions about every 3-4 mins apart. William woke up at 7am and chris took him downstairs to get breakfast and set him up with some morning cartoons. I had turned on my labor playlist that consisted of all praise and worship music and focused on God and my body through each contraction. The day went fast I moved between being on my hands and knees on the mat in the bathroom, to showering, to leaning over my bed, sitting on the exercise ball and taking a bath-repeat. For the most part of the labor I was feeling very positive and making it through each contraction but around noon I was feeling quite defeated. I will confess, I threw a hissy fit. I was exhausted, I had been in active labor since 6am, I felt as if my babies were never going to come, so I vocalized it, and cried to my husband and told him to tell me something, anything! He gave me a pep talk and reminded me that my body was made to birth our babies, and told me that I was strong and beautiful and reminded me that I was one step closer. I was. Each contraction brought me closer to my babies! Around 1:30pm I moved over to the bedroom, I was so tired, I wanted so badly to lay down and go to sleep, I wanted to be done, I wanted to hold my babies! William woke up from his nap around this time came over gave me a hug and kiss and chris took him downstairs to make him a sandwich for lunch and set him up again with more cartoons while I rested in the bed as best I could to regain some strength. About 15minutes later I was beginning to push. Xavier Cain was born at 2:15pm into daddy’s hands while I was on my knees on the bed. He came out screaming, so beautiful. We had done it! I laid in bed, held my baby on my stomach and let the cord stop pulsing as we took in our new son! William came up stairs after hearing Xavier crying. He was amazed, we all were! Within 10mins of Xavier’s birth contractions started up again. They came back fast and intense so I could not hold Xavier long, after Chris tied and cut Xavier’s cord he held him while I was working through the contractions. Alana’s water broke around 3:10pm a few contractions and 3 or 4 pushes later Alana Nicole was born. She came out quiet, eyes wide open, observing everything. After Alana’s cord stopped pulsing chris tied her cord and I cut it. Placentas were born shortly after with absolutely no difficulties or complications. We got cleaned up, changed the mat underneath me and chris handed me Xavier. I was holding both my new babies for the first time, in my own bed, in my home, with my family surrounding me. We can not imagine bringing our children into the world any other way.”

Mrs.Katt the Cat

I can’t even words right now.
Walking around for days, going out to eat, OMG I would have called an ambulance and demanded oxygen and fluids ASAP as soon as the waters broke.

What always amazes me about these stories is the nonchalant telling of all the mundane stuff they did WHILE IN LABOR. Either I’m a big weenie or they’ve all got savior/martyr complexes or something, because I cannot relate for one minute to “oh yeah, my water was broken and I was contracting but it didn’t slow me down!”

And then the older kid(s). Downstairs watching cartoons while Mommy is in the bathroom “vocalizing?” I try really hard not to judge others’ parenting choices, but I just can’t see how that’s healthy for anyone involved.

Mrs.Katt the Cat

Yes! Once I was in labor that was it- that was all I was doing until it was over. I ate breakfast, took a shower, and groaned my way to the hospital.
They couldn’t have gotten anyone they know to watch their other child?? What if that child had needed attention while all this was going on, unattended children are accident prone.

Reading between the lines, I don’t see how the older children of the birth junkies could be other than unattended much of the time. However easily one is able to breastfeed, that shit takes time, particularly in the first few months, and a lot of the other AP/crunchy stuff is time consuming as well–or seems so to me.

Wren

I’m not all AP or anything, but honestly breastfeeding my second was less time and attention taking than bottles would have been. That was not the case with my first. Since I was home alone all day with them, I couldn’t have asked dad or anyone else to feed her either. She happened to be good at latching and liked a sling, so it was pretty quick and easy.

In all fairness, the OBs at the practice I’m seeing don’t do an early ultrasound unless there is a medical indication. We got one because I’ll be 35 when the baby is born and am a twin myself, so screening for trisomies and extra babies seemed like a good idea. Outside of that, since I was trying to get pregnant and tracking my dates, my LMP date has been good enough so far.

CSN0116

This CNM didn’t even recommend an anatomy scan! Why would you not want advanced knowledge of abnormalities that may effect delivery or care immediately thereafter?!

Yeah, I can’t imagine passing up the 20 week scan. That just seems crazy.

nomofear

When I was deep in the woo, I found some article or website or blog or something that alleged that ultrasounds caused autism or…something. can’t remember the deets, point is that they’ll say anything to make modern tech evil

guest

Yep. There are a lot of people who either “know” or fear that ultrasounds damage babies. I saw something once that describe it as “scrambling” a fetus’s brain. And it doesn’t help that the FDA made an official recommendation that pregnant women avoid keepsake 3D scans and home doppler use – that just appeared to confirm the NCB fears about harmful ultrasound.

Azuran

Our professional order did an announcement last month to warn us all that, although they know there are no known risk to ultrasounds, we should stop doing U/S of your babies at work, just in case.
(because you know, with the kind of job we do, that’s what’s really dangerous to our babies)

guest

Oh dear. I have to say I didn’t love the million extra appointments that come with being high-risk, but I enjoyed each and every ultrasound and wished there were more. (I think there were about ten in total.)

I lost my first because of anatomical defects, so we had so many ultrasounds that I have an entire photo album of them for my son.

guest

I am sorry for your loss, but I’m glad you were able to get all those images.

BeatriceC

My middle child is named as a direct result of one of those million extra appointments and ultrasounds. We’d planned on naming him something completely different, but during one ultrasound the tech got an absolutely perfect view of his face and my very first thought was “This kid is a *name*”! And that is the name we gave him.

Azuran

Yea, I was really disappointed to being told that I didn’t need the date scan.

I felt the same way. I was high risk with both pregnancies and the silver lining was getting to see them and hear their heartbeats on the regular.

Azuran

Yea, initially I had decided to not check it myself (I do have a U/S machine at work) because I was scared I might see something ‘wrong’ and stress myself.
But when they told me I wouldn’t get a scan before 20 weeks, I did it. Because I kinda needed that baby to be something more than a blue + on a pee stick (and morning sickness).
So now I’m either having a brain shaped baby or I have a tumorous growth in my bladder :p

nomofear

Here ya go, first Google https://www.midwiferytoday.com/articles/ultrasoundrodgers.asp
On a side note, if you get a mosquito bite, a hot spoon against it does destroy the enzymes that make it itch. Like, make a cup of tea, leave the spoon in it while it brews, dry it off first, test it hot – not burn yourself hot 😉 their discussion on the heat from ultrasounds destroying enzymes reminded me

CSN0116

don’t mean “you” 😉

Irène Delse

Oh? I thought doing a check for multiples & anatomical defects was the standard of care? Or does it depend on the country?

My understanding – which may be flawed; I didn’t ask too much because I knew I’d be covered for a NT scan at 11-14 weeks due to my age – is that for younger mothers without any history of problems, a “naturally” conceived pregnancy and no family history of twins, the check for multiples and anatomical defects would be done at ~20 weeks. That scan seems to be sacrosanct.

For older moms, moms who conceived using ART and moms with a history of multiples in the family, an early scan is medically indicated and strongly recommended.

Anna D

I think that may depend on the state, as far as I know NT+ 2 blood tests for trisomy screening is covered by insurance in NY as part of standard care without any indications or maternal age.

CSN0116

My mo-di twins would have been dead from TTTS by 17 weeks. A 20 week scan would have showed nothing but two dead fetuses and I would have missed all opportunities for life-saving treatment. I didn’t start measuring large for singleton/twin until past 20 weeks and I was 21-years-old with no multiples history, so no “indicators” for me. Wow what could have been. Thank God in the US we get a quick dating scan (where most twins are caught), NT offered around 12 weeks (being phased out around me because they don’t show much and freak people out with false positives), and a 20 week anatomy. Anything outside of those three would be additional and for specific reasons.

Chant de la Mer

That check is done around 18-22 weeks, if anything pops up before then that hints there might be twins, like large for dates, then the provider would order an U/S. Also most women do opt for the nuchal translucency scan at 11-13 weeks just to get an early look at the baby and that will catch twins usually.

sara, MD

In the US, it is recommended to be offered to all women at 20 weeks – but because it is so not sensitive for birth defects, it is an optional test.

The Bofa on the Sofa

When my wife was pregnant with our first, I was hanging out at WTE and, the general sentiment there was that they all WISH they could get an 8 week scan, but that their doctors generally didn’t do them without indication.

My wife had some spotting, and so we got one, and they were all like, “Oh, you are so lucky. I wish I could get one!”

And I told them, um, no, when you see the referral sheet with the diagnosis, “Abortion – threatened” you don’t feel lucky at all.

They were even talking about how they could fake some symptom to try to finagle themselves an early scan.

The idea of not wanting an US at any point is just very foreign.

Anna D

In NY all of my friends and I were offered ultrasounds to confirm pregnancy/number of fetuses at original appointments and then all were offered nuchal translucency ultrasound at about 12 weeks and anatomy scan at 18-20 weeks.

guest

I was classed as high-risk from the get-go, but I thought an 8 week, 12 week and 20 week scan were standard for all pregnancies in NY. I think you could opt out of the 12 week nuchal cord scan without anyone causing a fuss, but they do like that early dating scan. *You* may know your LMP, but they don’t.

Margo

Interesting. In NZ we have blood test and scan for assessment of Downs, the risk is then calculated from result of bloods and scan measurements, history and age. Amnio offered if result high. Most women will then have the 20week scan to assess anatomy and gender if requested, also placement of placenta.

Wren

Same here in the UK. I actually had scans earlier with both of mine, but the first was due to bleeding at 6 weeks and the second to being hospitalised for severe vomitting at the same point.

Azuran

Well, number 1 isn’t a big deal by itself. Unless the mother has some medical need for an early U/S. I’m not getting an U/S before 20 weeks either, because I know the date of my last period, so they don’t need to date my pregnancy (and I’m being followed by an OB). I am considering lying about knowing my date next time, I am kinda disappointed to have to wait this long :p
But yea, not recommending the 20 week anatomical scan (and basically everything else in this story) is just pure bullshit.

swbarnes2

Nuchal translucency scans are done at about week 12, you can get a hint if the kid has Down’s. That’s worth knowing, even if you have zero intention to abort, you still need to get your specialists and special care lined up.

corblimeybot

Yes, I was given that one. I wasn’t older and had no other red flags, that’s just what my ob did.

Azuran

They do two blood screening at 10 and 12 weeks. If the result show an increased risks, the OB will prescribe either a nuchal chord or amniocentesis depending on the case.
I can get the nuchal chord on my own if I want, but without medical indication I have to pay out of pocket for it.

Azuran

Even those that get the week 12 dating scan don’t get the nuchal chord at the same time. They don’t do those around where I live. You have to go to the specialized medical centers a few hours away to get it.

AnnaPDE

Where do you live? I got an ultrasound in week 6 (even though I knew tffhe exact day of ovulation and sex) to check the heartbeat, then in week 13 for nuchal translucency, and then at every OB check because, “while you’re here anyway, why not have a look”. (The OB fee was a fixed amount, regardless of what she’d actually do in those 30min.) Plus the 30 week detailed scan.
That’s considered relatively normal here in Oz, at least for people “going private”.

Azuran

I live in a remote region, so that might play a role. Basically, the standard where I live is apparently a first meeting with a nurse at 6-8 weeks to get prescription for blood work and stuff. Sorting through obstetric history to see if you need special care or something. For low risk pregnancy, then you get a dating scan at 12 weeks if needed and an anatomical scan at 20.
The nuchal translucency is not routine here, but I think it’s more because there is no one in the region to do them. You have to go a few hours away to get one, so they do more available blood testing as a first line screening test. (But If I want one, I totally still can get one) The first actual meeting with the Doctor is at around 12 weeks as well. Then follow up appointments are decided depending on the situation.

But it’s a public system, and I don’t have my own family doctor to follow my pregnancy so I’m being followed directly by the hospital, and I have basically 0 risk factor for anything other than gestational diabetes (for which I’m doing an early detection test). So they don’t want to overcrowd it by doing multiple various appointments for things that could be grouped together later without having any effect on the outcome. Although it sure must be fun to confirm a pregnancy and heartbeat at 6 weeks. Medically, if there is anything wrong at that point, there’s nothing much to do about it, you’ll most likely end up having a miscarriage/abortion on your own. And really, since dating scans are also not the most precise thing ever, it’s probably not going to be any more precise than me knowing my last period date, since I’m regular like clockwork.

But the situation is different depending on your history. Those with a history of twins get early scans. My colleague with multiple miscarriage got scans every week from week 4 to 16. Those with IVF also get very early scans. Anyone who doesn’t know the exact date of their last period or have unregulated periods get the dating scan. A private doctor or a public doctor with his own clinic might also do things differently as well.

fiftyfifty1

“from my inner core to outer sanctum”

ish

demodocus

and other wooish pick-up lines

Heidi

That sounds like the process of digestion to me. And well he does seem to be full of it.

Roadstergal

“Outer sanctum” is what I am going to call the bathroom from now on.

Taysha

I love you. so much.

Roadstergal

Awww, and I love you guys. So many of my friends – smart women, educated women – are just SO into NCB, breastmilk woo, you name it. I think I would have brained myself on the nearest local wall if I didn’t have y’all to vent with.

guest

I love it. And when I’m having digestive problems, I will now say “I’m having some difficulty outing my sanctum” or “The door to my outer sanctum won’t close right now,” depending on the details.

Plus, as a GERD sufferer, my inner core is often a seething mass of molten lava – just like the earth’s inner core.

The Bofa on the Sofa

Is sanctum what the Japanese did to boats at Pearl Harbor?

Roadstergal

Sanctum? I barely knew ’em!

Karen in SC

that email totally doesn’t mean what they think it means. Any hospitals that allow labor in water has policies and procedures to safely remove the laboring woman from the tub. You know, safely.

Roadstergal

Either you have policies and procedures to safely remove a laboring woman from a tub, or you have some ugly slip-and-fall liability…

Heidi

Yeah, I’m totally having trouble how she read that email and interpreted it any differently.

Yeah, I was looking forward to a Nurse Ratched-esque threat about literally dragging women out of a tub. That’s not what the email says at all…..

Roadstergal

It’s almost like they can’t conceive (ha) of women wanting to labor in a tub, but also wanting to follow ACOG guidelines and not deliver in one. Or don’t want to poop in one. Or just get uncomfortable with being in one and want out. Etc. Stay in the tub and away from those evil Sweeny Todd doctors with their knives, just waiting for you to escape the water so they can give you a C-section!

Valerie

Worst case scenario, it’s way easier to drain a tub than forcibly remove somebody. The whole point is infant safety, and that would be defeated if they were proposing to manhandle the mother.

He’s out of his depth, and perhaps in a relationship with one of the women, but it’s not outside his area of expertise. Although he highlights certain issues, as one does in what is essentially an ad, I know very well what is required for the types of cases he mentioned, and this sort of case is well within what his competency zone would entail. Doesn’t mean he’s right in the end. But that’s a different question.

Anonymous

I bet the hospital recorded the entire encounter with these nutjobs. I’d love to have a recording of that.

PrimaryCareDoc

That email doesn’t say anything about forcibly removing women from tubs. It says that there will be policies and procedures in place about how to safely remove a laboring woman from a tub to a location that is safe for delivery.

This is probably a good idea, as moving a laboring, heavy, slippery, wet woman from a tub could lead to injury for both the woman and the care providers if there is not proper training and procedures in place.

Amy Tuteur, MD

See update above.

Trixie

Dr. Amy is magic. She infiltrates every single Internet forum and never sleeps. She’s a one-person NSA. She’s the Eye of Sauron.
Why can these people not understand that there are probably dozens of ordinary people in that group who are concerned about what they are reading? The cynical hypocrisy of these birth lunatics is readily apparent to many casual observers.

corblimeybot

You’ve nailed it. They’re paranoid and believe in actual boogymen. The idea that many people might object is incomprehensible. They’re just being persecuted by one reeeeaaaally meeeeeaaan supervillain.

Trixie

There’s no conspiracy here. Dr. Amy is the point person that people turn to when discussing home birth and natural birth tragedies. She doesn’t need to infiltrate anything. All she has to do is put her email address up there and maintain her reputation of integrity, which she does, and people will keep sending her this stuff.

I’m imagining Dr. Amy’s Maysesque response to a challenge to a debate against a woo-mongering home birthing CPM: “That would look great on your CV … not so good on mine.”

Roadstergal

“people who wish to make this group look foolish”

The people in the group are doing a fine job of that by themselves.

Amy Tuteur, MD

Worse than foolish!

Amy

Signed commitment? What’s the legality of getting Facebook to enforce a gag order here?

BeatriceC

I don’t know about a gag order, but I can tell you from personal experience Facebook is really quick on the draw to provide any information requested in a subpoena. It took about two days to get the court order for a certain set of private messages, and about two hours for Facebook to have them in the lawyer’s hands.

Sarah

They’ve improved then! Years ago I had to do something similar, for work, and it took rather longer for them to even respond.

BeatriceC

We could have just gotten lucky, but that’s what my experience was. This was just within the last couple months, so they could have gotten better.

That would be one of those issues for the courts to sort out – but I’m struggling to see how the courts would force FB to enforce a “confidentiality” agreement signed by outside parties.

The “owners” of the group can already remove group member’s privileges for violating the confidentiality agreement so FB isn’t actually needed there.

Violating the agreement doesn’t mean the users violated the “Terms of Service” for FB, so FB wouldn’t need (or honestly, want) to eliminate the accounts for the users.

I doubt FB would want (or want the standing) to try and censor other groups who shared information from the “confidential” FB group. In other words, FB would not want to have to bother the Skeptical OB page about taking down the next leaked information from the group.

kfunk937

I’d like to think that a court would laugh their “NDA” out of court.

But then I can’t wrap my head around what basis they thought they had to threaten legal action against DeKalb to begin with, or why those threats were supposedly decisive, unless the hospital wanted to avoid negative PR and the PITA of mounting a legal defence to frivolous suits .

Mattie

I mean, how would they even know who did it, you can copy-paste w/o anyone else knowing, or print screen… it’s just a ‘deterrent’ and not a very good one.

AA

Oh, Internet forums. Woman trying to conceive and wants to do a hospital TOLAC after four C-sections.

“Right now my risk of a .9% rupture with a 6% chance of catastrophic
ending; accreta at a 6% chance in its plateau(which is higher than my
current risk) and carries a 70% chance of hysterectomy and 21% chance of
maternal – fetal death; and any other problems relating to TOLAC is
STILL lower than the risk of having more csections.”

. The end result of this effort was a CS at 34ish weeks after she presented to the hospital wtih pain , previous abnormal liver function tests, and her waters broken. She was admitted and upon bringing her to the OR, the baby’s heart rate was 53. What happened? You guessed it, placental abruption. The baby was delivered less than 20 minutes after. Mother required blood transfusion and hysterectomy. Baby was fine.

This woman did have her care through the medical system, which was smart, but homebirth VBAC advocates…what do you think would have happened if she was under the care of a midwife? Can you really say that it would have been better?!?!

Karen in SC

Her risk after FOUR sections was in no way 0.9%, that is on the high end of vba1c. She probably read that on vbac-lies dot com. The risk after two sections is about 2-5% and there’s no good data on anything higher.

Karen in SC

and where the heck did she get 70% of hysterectomy with fifth c-section? I am just reading this wrong?

PrimaryCareDoc

I think she’s saying a 70% chance of a hysterectomy IF she gets accreta.

How hard is it to wrap your head around the fact that “he’s the only one still doing vaginal breech births” actually means “he’s practicing medicine that’s been outdated for 50 years”?

How hard is it to realize that a vaginal breech birth WILL cause your child to be born with lower oxygen levels – to the point that the SOCG guidelines tell doctors to expect the baby to be much more blue than normal?

How hard is it to conceptualize that placing an IV on a hydrated, normal BP patient is easy and placing an IV on a dehydrated, shocky patient is much, much harder?

How hard is it to realize that in a bleeding emergency blood products have to reach the circulatory system through an IV in minutes to save the woman’s life?

How hard is it to realize if you are pregnant for at least the fourth time after 3 C-sections that your body is better at giving birth through CS?

How hard is it to get that labor and delivery is the most risky point for a women to need an emergency surgery of her entire life?

How hard is it to get that aspiration pneumonia will seriously fuck up your magic baby bonding plans – although not as much as actual asphyxiation will?

AA

Some OBGYNs have contributed to this in the past, but for some women, trial of labor for a breech baby can be appropriate. However, for msot women, when given the truth about the risks of breech deilvery, they’ll opt for planned CS. But are they really being told the truth? Some women commenting on the page have a lot of misunderstandings that come from NCB–for example, saying that the Term Breech Trial results are misunderstood (saying that the babies harmed via vaginal delivery had medical issues causing breech presentation, and thus they were doomed anyway). And for the IV placement…I don’t think most of the supporters even know what that means. THey think that any sort of IV placement means you’ll be on a one foot tether and strapped to a bed. Completely not true! You can have a heplock for emergencies without compromising the whole “freedom of movement” concept.

A doula on DeKalb Medical’s FB says “Women are awakening to the fact that they want to be whole after birth, and water changes the game.” Insanity.

Also, I have NO IDEA why DeKalb Medical would be foolish enough to put practice changes on their social media.

AA

DeKalb is totally digging themselves in a hole by responding to the advocates’ emails. I have no idea what their PR and legal people are doing.

Haelmoon

The Term breech Trial is a fascinating piece of medical literature – rarely has a single article produced a sudden and sustained change in practice. It is almost as if they already knew that breech deliveries were more risky and were happen to have confirmation and a study to back up their practice.

The Term Breech Trial also taught us about how to make vaginal breeches safer. Babies with IUGR were over represented in the adverse outcome, therefore they are a contraindication. Large babies also did not fare as well, hence the upper limits of the weight ranges. Continuous monitoring in the second stage was better than intermittent monitoring. Long second stages were associated with worse outcomes. These things in hindsight make sense, but it is nice to have a randomized study to back up our information.

The reality is a vaginal breech delivery carries a small increased risk of death for your baby. But don’t forget that a cephalic vaginal delivery carries a small (but smaller than breech) risk delivery over a planned C-section. The long term outcomes (if baby survives) are no different.

There are maternal considerations which really can make a difference. If a mom is planning a large family, there may be benefit in trying for a vaginal breech to reduce the cumulative risk of multiple C-sections or VBACs. However, since the average Canadian family is one or 2 kids, that does not apply. The overall risk for moms are fairly equivocal because ~50% of planned breeches end up in C-section anyways. However, it you asked a baby, I suspected they would all prefer the C-section. No perineal trauma for the baby (just imaging caput on the butt, or labia/scotum). That alone makes me shudder. All breeches are more floppy at birth because of the cord compression. When you do enough breeches, you can appreciate which babies are going to be more difficult because as the babies become more hypoxic, they loose their tone, and you need a well flexed baby for an easy breech delivery. Otherwise, they extend their heads and there is a increased risk of head entrapment (worse than should dystocia in my opinion).

The SOGC does not recommend vaginal breech, it recommends that we support patient autonomy and may reasonably plan for a vaginal breech under strict circumstances. The NCB fans read the guidelines very differently than they were intended (I know, I participated in their production)

I think was is going on their is reprehensible. My jobs is safety of mom and baby. I hope that women are not traumatized and they feel well informed and supported, but my job is safety. I have some women who hate me because of that, but they have healthy babies, so I can live with that.

Roadstergal

“How hard is it to realize if you are pregnant for at least the fourth time after 3 C-sections that your body is better at giving birth through CS?”

I like this phrasing, and wish it could be more adopted. Instead of Erin’s ‘failed vaginal birth’ notes, have ‘successful C/S.’ Instead of ‘my body is a lemon,’ go for ‘my body is a champ at C/S delivery.’ Etc.

Erin

I definitely think changing the language would help. A lot of the women I’ve spoken with have attributed to their feelings of failure to essentially being told “you failed”, whether explicitly or implicitly.

I think the issue with “my body is a champ at c/s delivery” is that you don’t actually do anything apart from try to avoid bleeding to death and even then, it’s not as if you have any control over that.

It’s so stupid but one of the things that apparently really upset me (I can’t remember but it stood out to my husband) was the surgeon telling me what a brilliant job they’d done and that everything had gone back together really well. He says I burst into tears because earlier on during my labour, I’d heard midwives congratulating someone who had just given birth, whereas I just got the Doctors congratulating themselves.

Roadstergal

“I think the issue with “my body is a champ at c/s delivery” is that you don’t actually do anything apart from try to avoid bleeding to death and even then, it’s not as if you have any control over that.”

And I can totally understand how someone could think that. But for me, it all seems backwards. What do you do in a VB other than hope it goes well and scream if it doesn’t? I’ve had friends who had easy VBs, and they didn’t do much at all.

Having a baby at all takes a lot of agency out of one’s hands. A C/S involves you making a proactive decision on risk/benefit analysis, however, and that ain’t nothing.

Sarah

I think it’s as much being willing and able to get pregnant and carry to term after multiple sections, as the risk of miscarriage obviously increases.

The Bofa on the Sofa

I definitely think changing the language would help. A lot of the women I’ve spoken with have attributed to their feelings of failure to essentially being told “you failed”, whether explicitly or implicitly.

But who is telling them that, or sending the message?

Not the doctors. It is Ina May’s of the world, who tell them that having a c/s means their body is a “lemon.”

To borrow a phrase, to an OB, a c/s is just a “variation of normal.” It’s perfectly normal to need a c/s.

It’s the NCB loons who say things, “Your body won’t make a baby you can’t birth” (use of birth as a verb intentional).

This is totally on the NCB community. They set women up to make them failures, because, in the end, it benefits them.

Dr Amy has used the fashion industry as a model (whoa, another good pun). They set women up to think they should be size 2. Makes normal women feel like failures.

Erin

It was my Doctor who wrote “failed natural birth” on my notes. I’m pretty sure he’s not that invested in the NCB from conversations we’ve had.

He just didn’t see anything wrong with the choice of words.

In the UK, the NHS itself (possibly for financial reasons) has to shoulder a lot of the blame, with it’s desire for everyone to have normal/natural births.

It’s one thing to avoid the “NCB loons” and another entirely when the only system you have access to (being so far from London) is institutionally pushing the same message.

Or to put it another way, when you don’t actually see Doctors postnatally…you are just at the mercy of midwives who believe in the almighty powers of natural birth and breastmilk it’s hard to avoid.

Roadstergal

From my limited experience with a friend in the UK, the natural birth pressure there is just ridiculous. It definitely sounds systemic, and the midwives seem to have an inordinate amount of leeway to push their own agenda and to be shitty to women who don’t agree with them.

The Bofa on the Sofa

But that presumes that “unable to deliver by natural delivery” means that something is wrong. Who sent the message that failing to be able to deliver naturally means your body is broken?

When I do a maze, I make a wrong turn and run into a dead end, so fail to reach the end. Does that mean that I am stupid and can’t do a maze? Of course not, it means that that attempt failed.

Again, the NCB mentality sets it up that “correct” way to deliver is naturally, and if you fail to do that, it is a sign of a flaw.

You really get set up to fail, if it doesn’t go the way you are told it should.

Erin

The difference is in a maze assuming no Minotaurs, you get to try again.

I am a perfectionist in many ways. I’ve always been upfront as to why. I grew up with “no one loves a failure” from my Father when I came second in a race or worse fell over/hit a hurdle/missed a shot at goal at hockey and the reaction of my old English teacher on discovering my parents didn’t think that 97 percent was good enough entered school legend.

I do not cope well with failure so even in a world without the NCB I was probably screwed.

To me challenging the language is one way of tackling the problem and the NCB culture that infests our hospitals and yes, I’ve described our ante-natal classes before when c-sections, forceps deliveries and anything other than birth affirmations and unicorns weren’t allowed. In that environment, there is always going to be a degree of failure/feelings of upset if things don’t go according to plan and it needs to change before more women and babies get hurt.

Mattie

I totally agree, language is SO important. I wonder if it would be better to use Trial of Labour more…so elective section, section after TOL, emergency section. Because atm it’s either elective section or emergency section, and not all emergency sections are the same level of ’emergency’ (I know that sometimes you see ‘crash section’ used to indicate a very emergent situation). Sometimes women give labour a go, but the pain or effort means they don’t want to/can’t keep going, they tried it and went ‘nah’ that’s totally ok, and doesn’t indicate a failing on their part, or a failing of their body.

Wren

Would you push for a change to terms like “threatened abortion”?

This just seems a really odd place to start. I know the NHS is largely pro-natural birth, but the doctors I’ve met are less so. In your typical vaginal delivery, they aren’t even there. Heck, for my vbac the only time I saw a doctor at the birth was when there were concerns right at the end (cord around the neck causing some concerns), and even then it was a case of I looked up, saw them, pushed her out and they all disappeared. Doctors writing “failed natural delivery” is hardly the origin of or even a sign of the NCB culture.

Mattie

I don’t think it’s the origin, but I definitely think it’s a sign…and also it’s a way of combatting the idea that maternal choices have certain values attached (you didn’t fail at birth, your c-section is not (always) because your body failed and definitely isn’t because you did). I don’t really like using ‘abortion’ on handheld notes anyway, as for lay people it’s not always immediately understood to be a miscarriage, why not just be specific in notes? PV bleeding, abdominal pain etc… you don’t ‘know’ a miscarriage is definitely going to happen unless it does, many threatened miscarriages do not result in a pregnancy loss, so just put on notes what you 100% know for certain.

Wren

I think “failed natural birth” carries a different connotation to laymen than it does to doctors. The attempt at natural birth didn’t work out. That’s all.

The Bofa on the Sofa

I compare it to the diagnosis my wife got with our first when she had some spotting. “Abortion – threatened.” No, no one was threatening to get an abortion.

I agree with Wren. The statement is what it is. The question is, what is the source of the value judgement?

Margo

Again, could be written” spotting might be an indication that abortion may follow”….

Wren

But when we are talking about overworked staff (and the NHS definitely has that) is there a real reason to change the standard in notes written for communication between medical staff, not with the patient? “Threatened abortion” is shorter to write and is clear.

Margo

Yes that is true re shorter to write, however my understanding is that notes are often read by the woman and as has been stated here, how things are written can be very powerful. It is very unfortunate that under Staffing impacts in such a negative way. I believe that all patients should read their notes, have open acces to their notes….in some settings in NZ women are even encouraged to write in their notes, now that in my book is full participation in the process of ones care.

mabelcruet

Where I work, it’s been made very clear to all staff that the word abortion is not to be used because of the connotations. They are told to use ‘miscarriage’ instead-threatened miscarriage, spontaneous miscarriage, delayed miscarriage etc. Like much of the NHS, we rely on overseas doctors and nurses, so any that come from regions where abortion is commonly used are told at induction that they have to change the language. I know we’ve had a few complaints about someone entering ‘threatened abortion’ in the notes, even if it is an accepted and accurate clinical diagnosis.

Sonja Henie

Again, “spotting” doesn’t really say anything, medically.

Sonja Henie

That is a medical term. “Abortion” in medical lingo means In medicine, “the premature exit of the products of conception (the fetus, fetal membranes, and placenta) from the uterus. It is the loss of a pregnancy and does not refer to why that pregnancy was lost.

Every profession has its own lingo. “Abortion-threatened” simply means that a conditions for a miscarriage are present.

Erin

I understand that. I just think that using a word like failure which can have such negative overtones is unfortunate and that there are other words which would suit the situation and perhaps the hormones better.

Wren

As far as communication intended for the patient, I agree with you. In this case though, the communication is intended for fellow medical professionals.

Erin

Then it shouldn’t be left on your bed or anywhere that is easily accessible. I still stand by the fact that there are “better” ways of putting it if you’re going to leave it lying around.

Plus it fosters that “NCB” culture. Midwives can tell you that you failed and when you question their choice of words, point to the notes and say it’s not their fault, that they are using acceptable terminology.

Wren

I would report a midwife who said that to a patient. I’m in the UK and I cannot imagine any of the midwives I have known telling a patient “you failed” and pointing to their medical notes to show that.

Erin

It obviously wasn’t as black and white as that, however the person whom it happened to (not me) was deeply upset and essentially took that from it which is the point I’m trying to make. Words can hurt. Whatever that midwife meant to say to my friend, it got lost in translation and it contributed to my friend’s postnatal depression just as the comments that I got didn’t help my mental state.

Whether someone sets out to be cruel or not isn’t the point. My son had to go to NICU, my husband had already been sent home and I was effectively lied to about the whereabouts of NICU (now perhaps that’s my fault for not knowing the layout of the hospital before hand). For 9 hours I lay there thinking I was the worst mother ever because I didn’t know where my son was or how he was and no one would tell me. The midwives responsible thought they were doing me a favour because after 75 hours of contractions, waters broken for 81 hours and an emergency section after two hours of pushing plus 12 hours of looking after a new baby, I must have been exhausted and that I needed those 9 hours of sleep. They did the worst possible thing they could have for me, I didn’t sleep, instead I went for want of a better word, mad.

Before I had a child, I worked with vulnerable people and I spent most of my working day thinking about language, about what I wanted to say and how I was going to say it before I opened my mouth because in some situations, not doing so could get you hurt or could get someone else hurt. I don’t understand why other people working with vulnerable women can not do the same (and emotionally every woman I know, was vulnerable postnatally).

Margo

no, that’s a c out I think. Medical professionals need to remember it’s a fellow human being that’s being written about. “Failure to “can always always be stated in a different way.

RudyTooty

Thanks for speaking up, Erin. This helps me realize and remember how important it is to pay attention to the language I use when speaking with patients.

The language used among providers is often received very harshly by patients. This is important to remember.

kfunk937

Yes, the same language is used when other treatment attempts don’t work out, e.g. failed methotrexate. It documents what preceded a given situation in the history.

Inmara

Same here, for a single-payer healthcare system the “natural” way is cheaper – in a short term (and nobody tracks the expenses of repairing damage of natural birth disasters, usually it comes out of patient’s pocket anyway, as we have chronic shortage of funds and resources in whole healthcare system).

Azuran

I don’t think the intent of the doctors is to make them feel bad. But I still see how hurtful it can be.
But when a woman tries to have a
VB, and then ends up with a c-section for whatever reason….it’s kinda
hard to explain it in a way that doesn’t accidentally make it sound like
the woman failed at something…

Roadstergal

It does, but are there kinder words? “Unsuccessful attempt at vaginal birth?” “Fail” is a very, very connotation-heavy word.

I mean, I’m thinking right now of one of the too-damn-many TV ultrasounds I’ve had, where the technician offered to give me the wand to insert myself. I didn’t care one way or the other, but I was thinking of all of the people with trauma or sensitivity or the like who would really appreciate that, and it does make me think about little policies to make things easier, regardless of whether I, myself, would care if I were on the receiving end.

We all have our breaking points…

Monkey Professor for a Head

Successful caesarean birth?

Wren

Maybe, except that I think it does matter (medically I mean) whether it was a planned c-section that was successful or a c-section that was successful after a vaginal attempt was unsuccessful.

Glia

We already have “trial of labor” which I think makes a lot of sense. A lot of the medical literature I have read uses something like “cesarean delivery after trial of labor”, and I think that eliminates the negativity in “failed attempt”.

Margo

I worked with a GP who used to write “intention was to have a vaginal birth, however due to unforeseen circumstances ended up with the very best of alternative options, a Caesar.” Seemed to satisfy his patients.

Fleur

I agree with you about the NHS. Up to the point when I insisted on seeing a doctor at around 41 weeks, I only had access to my midwife and the midwives who ran the antenatal classes at the hospital. The hospital classes were drenched in woo, to the point where “trust birth” and “your body knows how to birth” slogans were displayed on a whiteboard at the front of the room on a loop throughout each class. Pretty much the only information I was given about inductions at these classes was that “they’ll want to induce you at 42 weeks but going over 42 weeks isn’t all that risky so you can say no”. The class tutor also didn’t get round to covering half the syllabus because she spent too long telling us that, even if we couldn’t have a home birth, we should labour at home until the last possible minute because primitive women evolved so that labour would stall if a woolly mammoth walked by outside their cave and being in a hospital has the same effect on labour as a passing woolly mammoth (I’m not kidding).

My midwife was the woman who told me after I had my elective c-section that she felt sorry for me because I would have a scar (this was in response to my saying that I was really happy with the way the birth worked out). She also tried to scare me out of having a c-section with non-specific warnings about the “terrible outcomes” that she’d seen in c-section babies – no details given, of course, including whether these were actually full term babies born via planned c-section. Plus she pulled some really vicious gaslighting bullshit over my family history of large babies, shoulder dystocia and stillbirth – apparently, women’s bodies can’t grow babies that are too big to birth, and the fact that my mother believes that her first son’s size was the main reason he got stuck, suffered oxygen deprivation and died aged two days just demonstrates that women go a bit crazy when they lose a baby and “believe things that aren’t true”. Bitch.

Sadly, I also agree with you that it all comes down to cost-cutting.

Melaniexxxx

Oh gosh your midwife sounds like a monster :O
I’m so sorry for your mother’s loss and for you having to deal with that witch

Roadstergal

That fashion industry is a good parallel, actually. Regardless of how unrealistic the expectation is, if someone said I ‘failed to fit into a size 2 dress,’ I’d feel a sting.

We use language about a woman’s body to represent the woman, and not her body part.

“You’re at 3 centimeters” vs. “Your cervix is 3 centimeters.”

“You’re not dilating” vs. “Your cervix is not dilating.”

“You’re not progressing” vs “Your labor is not progressing.”

“You’re ruptured” vs “Your amniotic membranes are ruptured. ”

It’s a subtle thing, but I think it goes a long way – especially for women, or some women, to not hear that the essence of themselves (YOU) is the failure, and is the part that isn’t working, and is the problem.

It may be a part of your body, or the baby’s body. Not YOU. Not wholly YOU that is dysfunctional. Right or wrong, words can hurt. It is hard when the woman is the object to not internalize those words.

I do believe shifting the language from woman as her body parts to parts of a woman’s body, can do a lot to alleviate feelings of failure by the woman in labor.

One of the reasons I like to say “Your baby needs a cesarean to be born safely.” versus “You need a cesarean.”

Words are powerful.

Wren

I think the effect of this kind of thing is likely extremely variable. Personally, when I went through fertility issues, I really didn’t care whether it was just my ovaries or me that wasn’t ovulated. I just wanted it fixed. When my son was a footling breech I didn’t care whether I was told “I” was breech, “My baby” was breech or any other phrasing. I just wanted the baby out safely. I truly do not think the feelings of failure (and I had them) after a C-section come from the words used at the time or those written on medical notes, but from societal expectations and the massive amount of NCB thought that has taken over, especially in the prenatal books, blogs, forums, etc.

Erin

I’m not saying that the wording is the whole source of the issue because it obviously isn’t. However we can not change those societal expectations without beginning somewhere.

Wren

Language in medical notes seems a very odd place to begin.

Instead challenge the claims the c-sections are somehow the easy way. Challenge the “too posh to push” we hear all the time.

If you want to go after something in the NHS, go after the units that make it hard to get a c-section. Go after the midwives who manage to delay epidurals until it is too late. Go after the ridiculous state of affairs that leaves bed bound, post-c-section women caring for their newborns alone. There are literally dozens of things that would help more than making doctors write a different phrase in the notes that most women don’t even glance at.

The idea that a section is a failure is established long before the birth. I know I planned to avoid one at almost all costs. I was so sure of my natural birthing ability I didn’t even attend the antenatal class run by the hospital on the day c-sections were covered. My sense of failure had nothing at all to do with medical terminology, but with my expectations and societal beliefs.

Erin

Language happens to be a passion of mine. You might not care about medical terminology but its a common theme in the Birth Trauma and VBAC groups I have been apart of (prior to ending up here, my plans for baby two were dubious in the extreme).

Everything you suggest for the NHS costs money. Something apparently it doesn’t have. I did complain about the fact that I was left for 81 hours with a clearly dysfunctional labour and broken waters, I have repeatedly complained about the shocking post natal care I encountered. I do whenever I can push that section recovery varies hugely and that vaginal doesn’t always equal damage free. I’m pushing for realistic ante natal classes, we didn’t even get to discuss sections last time around. I believe that maternal request sections and epidurals should be freely available (I was fully dilated when I got mine, he was transverse at the time).

I was a Civil Servant once. You don’t change institutions like the NHS overnight and doing it head on rarely works. People close ranks and files go missing. You pick a corner, a weak spot people don’t care about or think matters and you pick, scratch and dig from there.

Wren

Refusal to discuss c-sections in a hospital antenatal class seems an excellent place to start, and somewhere you could likely get some support from the doctors in the hospital too. Changing the terminology in the medical notes won’t change the ideas patients come in with. It would not be a cost-free exercise for the NHS to change the nationally used terminology, as it would require training sessions (however short), time to check it is happening and would likely still see no change in the attitudes of those who write the notes (who generally do not see a c-section as any kind of failure on the mother’s part anyway) or those who read them the majority of the time.

Erin

And that’s where I think we disagree. The language we use around birth definitely plays into the dominant NCB narrative. Failure to progress, descend, failed natural birth, natural, normal and of course the silent antonyms, abnormal, unnatural. I would like to change it all.

Language underpins societal expectations, we reinforce them to our daughters and sons whenever we describe normal birth as being just that. Change the words and we shift those perceptions.

Margo

The sense of failure and expectations is often felt by the midwife as well, I remember early on in my training feeling we, the midwives, had somehow failed when the women ended up with a Caesar. How silly is that…..looking back now, seems pretty silly that my training instilled in me that a Caesar was somehow a midwifery failure…I was “cured” of this sense of failure when I started listening to some of the women who were more than happy and relieved to have had a Caesar, when a baby was saved by a Caesar or some other timely intervention. I was “cured” when I stopped buying into expectations that only a vaginal birth was meaningful.

Erin

They are yes and I know as a rape survivor I have extra baggage in that department. I find the breakdown harder to deal with than the whole probably because the last time I got reduced to a body part, it didn’t end well.

For example after having his hand inside me, the OB who delivered my son looked down at my stomach when I was in labour and went “Oh, good job at avoiding stretchmarks” or something similar. I promptly had a panic attack about the fact that he was looking at my stomach and nearly kicked him in the face. I could cope with things I deemed necessary in a childbirth setting but I couldn’t cope with any other references to my body regardless of how well meant they were.

For a multitude of reasons, we can have issues with our bodies and their constituent parts.

I suppose it comes down to disclosure which I fully admit I totally suck at in person.

demodocus

i wonder if letting your ob know about your persona here might help give them the info indirectly or if knowing they might be reading would inhibit you

Erin

When I read this I had a major anxiety attack and nearly deleted my account.

I think though if any of them were lurking, they would be trying harder to make me sit down with a psychologist…unless eek they think this works as therapy the NHS doesn’t need to pay for.

demodocus

oh, god! I’m sorry!!

Erin

Really was an oversight on my part which I should have thought of, was always going to happen when someone pointed it out/it dawned on me.

Also I’m prone to overreacting.

demodocus

*imaginary hugs*

guest

They are. My midwife and consulting doctor tried to improve my daughter’s heart decels for a while before deciding to recommend a c-section. The words they said to me were “At this point we’re really worried about your daughter and think a c-section is best.” (Note: this obviously wasn’t a crash section situation.) I readily consented. If they had said “You need a c-section,” I can imagine that I would have stalled my consent by asking questions – is it *really* necessary? why? Etc. Part of that is NCB types warning people about “pushy” doctors, so language I might have accepted sounds aggressive now. But the simple statement “we are really worried about your daughter” was the part that sold it.

sara, MD

Thank you for this. If I ever am back in the OB world, I am going to make sure I speak like this.

Melaniexxxx

OMG! Subtle but very powerful! Thank you, doing obstetrics ATM and definitely going to use this phrasing. I have managed to eliminate ‘failure to progress’ but the dilation phrasing and “your baby needs” are great points to remember

Azuran

I’d say, because at this point, it’s not about facts and safety. It’s about feeling.
Everyone want’s to think they are a special snowflake and that they know what they need, and they just know in their tender hearts that nothing is going to happen to them. So they don’t need all those safety measure, they are just annoying and interfering with their special unique moment.

AA

Quote from a CPM
“We ask our VBAC clients, to turn inside, dig deep, and clear out any
emotional trauma before giving birth the next time around. In doing so,
our VBAC rates tend to be very successful. ”

AKA “Did you have a c-section, mama? Your mental state must have contributed”

Azuran

Getting around the fact that sometime, things happen, and we have no control over it, is extremely hard. We always want to find something or someone responsible, and blaming yourself is often the easiest.

Roadstergal

Blaming the OB is even easier…

Heidi_storage

Revolting, but very much what I’d expect from the woomeisters. Basically the same (despicable) attitude that results in blaming people for dying from cancer instead of thinking positive thoughts and following whatever magic diet is supposed to be infallible.

Irène Delse

“How hard is it to conceptualize that placing an IV on a hydrated, normal BP patient is easy and placing an IV on a dehydrated, shocky patient is much, much harder?”

My mother was the kind to tell birth stories of her friends. One of these stories was terrifying: woman giving birth vaginally after a textbook labour, all going well… And then a violent hemorrhage and the doc scrambling to put a needle into a rapidly depleting arm vein. That was in the 1960s, and obviously having least a hep lock has become the standard of care. But stories like that are useful.

Azuran

I hear you. Our worst cases are usually the Addison crisis dogs. They are usually severely hypotensive and hypothermic…. It once took over 1 hour, over 30 IV catheters, 6 different techs and 2 vets before someone managed to get an IV access in that dog. And you don’t often get that much time and that many tries.

I hear you. Once in a blue moon, we have problems starting an IV on a cow when something goes wrong. I mean, a cow’s jugular vein is huge compared to a human and once the cow’s BP gets low enough it’s like the vein disappears. Trying to place an IV on a hypotensive dog…..damn.

mabelcruet

Out of interest, do you do cut downs on animals, the same as people sometimes need if they are really hypotensive and fading fast?

Azuran

I’ve ‘learned’ the procedure…(By taking 30 minutes to manage to do it once on a dead dog at school.) I’ve considered doing it about 3 times, but each time someone managed to get the IV access. The above case happened on a day I wasn’t there, I guess I probably would have done it if it was my case.
Intraosseous catheters are also possible… But again, my training in those consist basically of once breaking the tools in a dead dog’s bone… and I’m the only vet at the clinic who had any training in it.
But those procedures are done a lot more in an actual specialized emergency vet hospital.

mabelcruet

When you do anatomy at vet school, what animals do you dissect? In medicine we just did human (obviously!) but wouldn’t you need to do lots of different animals, like a sample mammal, sample reptile, sample bird etc, or do you just do the ones you intend to specialise in? One of my cats is currently being investigated for breathing problems-she’s getting imaging and endoscopy next week-I dug out my old stethoscope and had a listen, couldn’t make out a thing!

The Bofa on the Sofa

I know my wife had to dissect a chicken at one point (I stopped over to visit them in anatomy class that day)

demodocus

Seeing this made me want chicken for dinner. Is that weird?

Mrs.Katt the Cat

Not at all
(This from someone who reacts to PETA propaganda with carnivorous cravings)

The Bofa on the Sofa

You know all those stringy parts of the leg and stuff? Yeah, they are nerves, and she had to know them.

demodocus

tasty nerves mmm

mabelcruet

The pathologist that initially got me interested in perinatal pathology was asked to do an autopsy on a baby gorilla many years ago-the mama gorilla at the local zoo had three infant deaths and no one knew why, and the zoo vet thought a perinatal pathologist was probably better placed to look at it. Poor baby gorilla stayed in the freezer at the mortuary for ages afterwards-the zoo wouldn’t take him back.

The Bofa on the Sofa

I’ve said it before, and don’t take this personally, but pathologists are weird. Scary weird. Scary SMART, too, but just weird.

I know quite a few pathologists. They scare me.

There is something wrong with you people. Seriously wrong.

mabelcruet

Oi! I’m perfectly normal! I did 2 years of proper medicine, but I have to admit I wanted to be a pathologist from 1st year at medical school. I really didn’t enjoy clinical medicine-I was always worried that I would make some horrendous mistake and I found it incredibly stressful. My nightmare job would be GP/family doctor, I would end up overinvestigating and over referring because risk management is not my strong suit. Pathology is much more black and white (well, pinky-purple and blue).

Edit-when I got my kittens neutered I asked the vet if I could have one of his testicles. I processed it in the lab and it looked identical to human testicles, except he was producing sperm at the age of 5 months. I suppose that could be considered slightly weird.

Azuran

We get a dog (in teams of 3 usually) Dogs and cats are practically the same. Then the teacher will do both a cow and a Horse (because getting 30 of each and dissecting them would require a ridiculous amount of space and work.) and there are theoric bits about the specific difference of a few other species.
There are no direct dissection of exotic animals, this part is strictly theoric and given mostly as optional courses. There are just too many variation between too many species, it would be impossible to find all those animals and have the time to dissect them all.

Then we have specie specific surgery classes, depending on the species we want to work in.

mabelcruet

That makes sense-I’ve seen various animal tissues microscopically (pig, rat, cat and dog) and they all look very similar, I suppose all mammals have the same sort of body pattern.

Azuran

Yea, so long as you stay in the same class of animals, the frame is basically the same, with some minor twitch here and there. Like the number of ribs, number of liver and lung lobes.
Most of the differences are in the digestive system, the extremities of the limbs and the head.

Charybdis

I remember one of my college friends working on a horse. Hers had some horribly overgrown and foundered hooves.

BeatriceC

The one well-known reproductive issue with birds is egg binding, and, as you know, is frequently fatal. Cookie, our cockatiel once had two cage mates. The female died from becoming egg bound, even though they rushed her off to the vet as soon as there was any indication of a problem, I nearly didn’t take Charlotte because she’s female and I fear egg binding more than I fear anything else with birds.

Azuran

I wouldn’t be too worried with bigger birds though. Although egg binding is common in small birds like finch, budgerigar, and cockatiels, larger parrots are actually a lot harder to breed and will usually only very rarely lay eggs without a proper nest and mate. But if they ever start laying eggs, you could have a contraceptive implant put in. It did wonders for my cockatiel.

BeatriceC

Yeah, I know it’s less of a concern with the bigger birds, but I’m still scared enough by the prospect that it did factor into my decision to take her. The lower chances in bigger birds, plus the instant connection when I met her overrode my worries.

And actually, we’re considering birdie birth control as a way to address the plucking. She’s not plucking as bad as she used to, but still enough to be problematic. The thought is that if she doesn’t have to deal with hormones quite so much, that will eliminate one of her stress points. The Haldol isn’t working as hoped.

nomofear

My 95 year old grandmother lost dear friends to PPH back in the forties and fifties. In retrospect, I feel awful for the stress that I midst have put her through when I was using a freestanding birth center to have my oldest. She was wise enough not to mention it (I doubt she, or anyone, could have swayed me at that point), but my goodness, she must have been so incredibly worried for me.

mabelcruet

Pregnant women normally have veins like hosepipes-if you can’t place an IV then the patient is likely to be horrendously depleted.

Chant de la Mer

Mine are always crappy when I’m pregnant, I suspect because of low BP but don’t really know for sure. It takes a lot of work to get an IV in me or get blood out of me when I’m pregnant and it’s even worse once I”m in labor.

I have good veins for blood draws, but my husband’s veins are really hard to get anything placed in. I tell him not to worry, though, because his veins clearly have developed the ability to retract and hide when sharp objects are nearby and that is a great survival mechanism…..

One of the See Baby midwife supporters is excited about the planned vaginal delivery of twins, in which Baby A is frank breech. THe physicians who have commented on this blog agree that this is a very risky prospect.

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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